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ACCORLY CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />03129r2019
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed,
<br />If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on
<br />this Certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
<br />PRODUCER
<br />NRME CT Marilyn Hagler
<br />The Juban insurance Group LLC
<br />PHONE
<br />ND Ext (225) 291-0405 AIu No): (225) 291.0420
<br />4319 Bluebonnet Blvd
<br />EMAIL ADDRESS. n@) marl!Y ubaninsurance.com
<br />[NSURER(S) AFFORDING COVERAGE
<br />NAIC A
<br />Baton Rouge LA 70809
<br />INSURERA: Certain Und @ Lloyds of London
<br />AA-112200C
<br />INSURED
<br />INSURER B; Travelers Indemity Co of CT
<br />25682
<br />Utlliworks Consulting, LLC', Utliiworks, LLC ✓
<br />INSURER C ;
<br />2361 Enargy Drive, Sto- 1010
<br />INSURER D :
<br />INSURER E t
<br />Baton Rouge LA 70808
<br />INSURER F I
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUS9ONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />JNSPOL)CY
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />EFF
<br />MM43DIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />x
<br />COMMERCIAL G5NERAL LIABILITY
<br />CLAIMS MADE
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />OCCUR
<br />PREMISES Pacccufrenna
<br />$ 250,000
<br />MP EXP (Anyone person)
<br />$ 51000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />A
<br />PSH05720413
<br />08/06t2018
<br />0810612019
<br />GEN'LAGGREGATE LIMITAPPLIES PER'
<br />%� POLICY ❑ PRO- ❑
<br />LCC
<br />OENERALAGGREGATE
<br />$ 4,000,000
<br />JECT
<br />pRODUCTS•CCMPlOPAGG
<br />$ 2,000,000
<br />aTl-iER;
<br />Employee Benefits
<br />$ 2,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />❑OMa1NED SINGLE LIMIT
<br />Ea accident
<br />$
<br />ANYAUTO
<br />BODILY INJURY (Par person)
<br />$
<br />p
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTDS
<br />PSH05720413
<br />08/0612018
<br />08/06/2019
<br />BODILY INJURYiI'aracnidenp
<br />$
<br />x
<br />HIRED NON-OWNBq
<br />AUTDS ONLY AUTOS ONLY
<br />PRDPERTY DAMAGE
<br />Per ocnidenl
<br />$
<br />Hired And Non -Owned
<br />$ 1,000,000
<br />UMBRELLA LIAB
<br />4OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />bEb RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />!� STATUTE ER"
<br />B
<br />YIN
<br />RIBEXLbE7ECUTIVE
<br />OFICERIMEERCUb]
<br />NIA
<br />UB-BJ38926-18
<br />10/01/2018
<br />10/0112019
<br />ELA
<br />1,000,000F
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 11000,000
<br />(Mandatory In under
<br />und Ifyes,
<br />E.L, pISEASE -PDLICY LIMIT
<br />$ 1,000,000
<br />OE5CRIPT30N
<br />IPC OF OPERATIONS below
<br />Professional Liability
<br />Each & Every Claim
<br />$2,000,000
<br />A
<br />Errors & Ommissions
<br />PSF106720413
<br />08/0612018
<br />08/0612019
<br />Aggregate
<br />$2,000,000
<br />Deductible
<br />$5,000
<br />DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (A CORD 101, Addlilonal Remarks Scheduln, may be attached If more space Is required)
<br />CyberlTechnology Liability $2.000,000 Each Claim $2,000,000 Aggregate.
<br />Applicable to Certificate Haider. Blanket Additional Insured, Primary Non -Contributory basis, 30 days notice of Cancellation (10 days for non-payment) and
<br />Wavier of Subrogation included in the General Uab€ilty Genaral Condition warding, If required by written contract. nke e S ttj In yf
<br />certificate holderwhen required by written agreement with respeots to Workers Compansation.�
<br />CERTIFICATE BOLDER r,AA,rrm r ATrrM A P1 I' 1
<br />SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN
<br />City of Santa Ana, The City, Its officers, amployees agents, volunteers &
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />representatives as addl lnsds
<br />AUTHORIZED RaPRESENTATIVE
<br />20 Clvlc Center Plaza
<br />Santa Ana CA 92701
<br />©1988-2015 ACORD CORPORATION. Ail rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />V/
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